| NPI | 1124316310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PR 0244) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2025-01-09 |